March 21, 2012
Volume 7 - Issue 12        

DynaMed Weekly Update

For the week ending March 16, 2012  

Last week 528 articles were evaluated via DynaMed's Systematic Literature Surveillance and 228 were added to DynaMed content. 

Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update.

Feature Article

Targeted Shoulder Exercises Improve Function and Reduce Surgery for Subacromial Impingement Syndrome


Impingement syndrome is a common shoulder ailment causing pain and loss of function. Usual treatment includes steroid injections and physical therapy, but treatment failure is common, and as a result, nearly a third of patients may eventually have arthroscopic decompression surgery. A recent randomized trial evaluated the efficacy of an exercise program targeted to improve function and reduce the need for surgery in 102 patients with persistent subacromial impingement syndrome that was unresponsive to conservative treatment.


Patients (mean age 52 years) with symptoms for > 6 months who were on a waiting list for arthroscopic surgery were randomized to 1 of 2 supervised exercise programs for 12 weeks. The specific targeted exercise program included eccentric strengthening exercises for the rotator cuff, concentric and eccentric strengthening exercises for the scapula stabilizers and manual mobilization. The control program included general movement exercises for the neck and shoulder. All patients had a subacromial corticosteroid injection 2 weeks prior to initiating exercises, education on ergonomics and posture, individual physical therapy and a home exercise program.


At the end of treatment, the targeted exercise group had a significantly higher rate of patients reporting either recovery or large improvement in symptoms (69% vs. 24%, p < 0.001, NNT 3) (level 1 [likely reliable] evidence). Surgery was performed on 20% of the targeted exercise group vs. 63% of controls (p < 0.001, NNT 3). Targeted exercise was also associated with significantly improved health-related quality of life. There were no significant differences in the use of analgesic or anti-inflammatory drugs (BMJ 2012 Feb 20;344:e787). A data supplement to the article includes instructions for the exercise program (PDF).


For more information, see the Impingement syndrome of rotator cuff topic in DynaMed.

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DynaMed Extra

New Cervical Cancer Screening Guidelines Recommend Less Frequent Screening


New recommendations for cervical cancer screening from the United States Preventive Services Task Force (USPSTF) (Ann Intern Med 2012 Mar 14 early online full text) and from the American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology (ACS/ASCCP/ASCP) (CA Cancer J Clin 2012 Mar 14 early online full text) were published in March. Both statements recommend cytology screening beginning at age 21 years for women at average risk (women who are not immunocompromised and have no history of cervical cancer or in utero exposure to diethylstilbestrol). Cytology (Pap smear or liquid-based cytology) is recommended every 3 years for women through age 29 years. For women aged 30-65 years, the screening interval can be extended to once every five years if co-testing with both cytology and human papillomavirus (HPV) testing is used (or once every 3 years for cytology alone). Both groups recommend no screening for women > 65 years old who have adequate prior negative screens.


For more information, see the Cervical cancer screening topic in DynaMed.
Call for Peer Reviewers

We are currently seeking reviewers for:   

Dupuytren disease

Neuralgic amyotrophy

Transient synovitis of the hip


Learn more about the DynaMed Contribution Opportunities:

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About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information


0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
Release Date: March 21, 2012 
Expiration Date: March 21, 2013
Estimated Completion Time:
15 minutes
There is no fee for this activity.

To Receive Credit 
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.
Faculty Information
Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
No commercial support has been received for this activity.

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ACCME This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians.  Antidote Education Company designates this educational activity for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: This activity, DynaMed Weekly Update 2011, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins March 2, 2011. Term of approval is for one year from this date. Each Weekly Update is approved for 0.25 Prescribed credits. Credit may be claimed for one year from the date of each Weekly Update.


AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.  

Program ID 1102072C.

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